Rape Kit Tracking Enrollment Form

To participate in the Tracking System, a medical provider or law enforcement agency shall submit an electronic enrollment request via the AGO’s online platform.

To participate in the tracking system, please let us know who is submitting this enrollment form.
Are you a: (required)

Enrollment Information

Point of Contact Information

Personnel Information

Please list the name(s) of all other personnel of the medical provider/law enforcement agency who request credentials to access the Rape Kit Tracking System, along with (for each person) the individual’s name, title, date of birth, business address, business telephone number, facsimile number, and email address.

I certify by submission of this form that the medical provider/law enforcement agency will:

  • provide electronic notification to the appropriate medical provider/law enforcement agency when the provider has a reported or anonymous evidentiary collection kit;
  • comply with the Protocols;
  • promptly notify the AGO of any violations of the Protocols by the medical provider or its officers, employees, or agents; and
  • comply with all applicable checklists, protocols, and procedures issued pursuant to § 595.220.3, RSMo.